The Skin Cancer Foundation Photosensitivity Report - Medications

Medications Included in This Overview:

Select a medication to learn more about it.

1. Oral Medications

a. Antiarrhythmic

i.Amiodarone

Amiodarone is an oral medication that belongs to a category of drugs known as antiarrhythmics, which are used to correct a heart that beats at an irregular rhythm. Occasionally the medication can make the heartbeat even more erratic or can cause a normally beating heart to lose its rhythm, making it important that those taking it follow their doctor's orders very closely. Often those starting a treatment of amiodarone will be monitored for the first few days until their doctor finds that their body has responded to the drug in the desired way. It is also important to note that the medication only controls the heartbeat while the patient is taking the drug, but it does not permanently correct arrhythmia. Patients taking this medication will rarely develop lung or liver disease, so it is very important that you tell your doctor of any past problems with these organs and that they are carefully monitored when you are taking amiodarone. This medication is sold under the brand name Cordarone.

A number of precautions must be followed while taking amiodarone. Grapefruit can cause the body to have an undesirable reaction and should not be eaten while the drug is being taken. Certain medications can also interact badly with amiodarone, so it is incredibly important to make sure that those taking the drug inform their doctor of any other treatments that are being taken.

In addition, sunlight can cause skin to become a permanent blue-gray color and exposure should therefore be avoided when possible. When the skin is to be exposed to UV radiation it is crucial to protect it by wearing protective clothing such as a wide-brimmed hat, long sleeves and pants. Another important defensive step to take is applying a broad spectrum high SPF (30+) sunscreen to any exposed areas.

ii.Quinidine

Quinidine is a medication that is classified as an ‘antiarrhythmic,' meaning that it is used to steady an irregular heartbeat. If the drug is properly taken it is usually highly effective, but in rare cases it can cause serious damage to the heart as it causes normal heartbeats to become severely abnormal. When the drug functions properly it allows its user to perform normal tasks much more easily and with less stress. Blood thinners are sometimes used prior to a quinidine dosage is started so that blood clots can be eliminated before the heartbeat is corrected. The medicine is sold under the brand names Quinaglute or Quinidex.

Quinidine functions by minimizing the speed of the heart muscle's electrical conduction, elongating the amount of time required for the electrical phase to be created when the heart muscles are electrically stimulated, and by extending the amount of time required for the recovery period of the heart muscle cells.

Occasionally patients will experience a photosensitive reaction in which exposed skin undergoes an abnormal response to the ultraviolet rays of the sun. This can be avoided by minimizing the amount of time spent in direct sunlight when possible. In addition, application of a broad spectrum, high SPF (30+) sunscreen and wearing protective clothing can reduce the effects of UV light.

b.Antibiotic

i.Ciprofloxacin

Ciprofloxacin is a quinolone, which is a type of antibiotic (drugs that are used to kill bacteria). In particular, this medication most commonly destroys those bacteria that cause urinary tract infections. The medicine is sold under the brand names Cipro XR and Proquin XR. Patients usually see improvements within 2-3 days of treatment, even if the bacteria was previously resistant to the commonly used amoxicillin. In addition to basic kidney infections, other aliments associated with the invasion of the kidney itself can also be treated with ciprofloxacin including high temperature, nausea and chills. Ciprofloxacin is also a crucial medication in treating those that have been exposed to the anthrax-causing bacteria.

It is important to note that quinolones can impede the growth of certain parts of the body including teeth, bones and cartilage. Therefore it is crucial that this medication is not used in those that are younger than 18 years old.

For those that are receiving this drug in an attempt to eliminate a urinary tract infection, treatment usually lasts 3 days but can take up to 10-14 days in more severe bladder or kidney infections. Even if symptoms have subsided it is very important that all prescribed antibiotics are taken. This increases the chance of eliminating all bacteria, which in turn reduces the likelihood of a second infection by drug-resistant bacteria.

Those taking ciprofloxacin occasionally develop photosensitive skin, in which abnormal reactions to sunlight commonly occur. In order to avoid this it is important that patients avoid direct sunlight whenever possible. Additionally, applying a broad spectrum, high SPF (30+) sunscreen and wearing protective clothing such as pants, long sleeves and a wide-brimmed hat are all helpful behaviors in minimizing outbreaks. Patients that are taking ciprofloxacin at the same time as other medications must notify their doctor prior to beginning their treatment, as ciprofloxacin reacts with a large number of over the counter and prescribed drugs.

ii.Co-Trimoxazole

This medication is used to fight bacterial infection and is actually a combination of two drugs, trimethoprim and sulfamethoxazole (a member of the 'sulfa drugs' group), that can be taken orally or by injection. It is sold under the brand names Bactrim, Septra, and Sulfatrim. Co-trimoxazole is most effect in killing the bacteria involved in urinary tract, ear, and respiratory tract infections. In addition, this drug is also helpful in treating traveler's diarrhea, or Pneumocystis carinii, often found in patients with AIDS or cancer.

Those taking co-trimoxazole commonly see an improvement in their infection within 2-3 days of treatment. Dizziness and potential kidney problems are occasionally observed in patients, so drinking a large amount of water to keep hydrated is very important. Because co-trimoxazole can cause an upset stomach it is important to take the medicine during meals. For those taking methotrexate, phenytoin (Dilantin), warfarin (Coumadin), or vitamins, it is crucial that the doctor prescribing prior co-trimoxazole is informed prior to beginning treatment in order to avoid an adverse reaction to the medicine.

Co-trimoxazole is known to cause an increased sensitivity to the sun, a disorder known as photosensitivity. For this reason it is important that those taking the medication defend themselves from the sun by wearing protective clothing including long sleeves, pants and a hat, and that they also apply a high SPF sunscreen. Avoiding direct sunlight greatly minimizes outbreaks due to exposure to UV radiation.

iii.Dapsone

Dapsone is an antibiotic medication that is prescribed for treating a number of skin disorders including leprosy, dermatitis herpetiformis, Hansen's Disease, and skin infections. This is achieved by reducing inflammation and destroying the bacteria that causes these infections. Dapsone is also utilized to prevent a number of infections that are associated with HIV including pneumocystis pneumonia and toxoplasmosis. The medication, however, is ineffective against viral infections. Dapsone is a sulfone drug and is sold under the brand name Aczone.

Those taking Dapsone occasionally experience a number of side effects from the drug including vomiting, nausea and anemia. In addition, women that are breastfeeding while taking the medication may pass it on to their children through breast milk, causing a number of illnesses in an infant. Therefore it is highly advisable to avoid breast feeding or to discuss discontinuing the medication with a doctor to ensure the healthy development of the baby.

Rashes and other abnormal skin reactions caused by an allergy to this drug occur in certain patients but are usually mild in severity. Occasionally these rashes will become very severe in which case medical attention is needed. Additionally, the sun can sometimes irritate the skin and worsen the conditions of the rash, making it important to avoid exposure when possible. Wearing protective clothing such as long sleeves, pants, and a wide-brimmed hat, as well as applying a broad spectrum, high SPF (30+) sunscreen are helpful activities in defending oneself from the dangers of UV radiation.

iv.Tetracycline

Tetracycline is an oral antibiotic, meaning it is used to fight bacterial infection, and is sold under the brand name Sumycin. In particular, the medicine has been prescribed for treating skin disorders including rosacea and acne vulgaris as well as infections of the urethra and pelvis for more than fifty years. The medication functions by binding to aminoacyl-tRNA enzymes that are a key part of DNA translation in bacteria. By stopping this molecule from binding to the ribosomes in bacterial cells the tetracycline impedes the bacteria's ability to create vital proteins.

Decades ago tetracycline research proved that this medication can result in the formation of a phototoxic reaction, although only to a small degree. Although the mechanism that causes the medication to become phototoxic is unclear, it appears to be oxygen-dependent and can result in altered cell membranes and DNA. Of the many derivatives of tetracycline, the most common form that causes increased photosensitivity is doxycycline, and the least likely to cause the reaction is minocycline. With all tetracycline medications, however, a higher dosage often results in a greater sensitivity to UV radiation.

It is of crucial importance that patients who are on tetracycline make an active attempt to defend their skin from the dangers of the sun's rays. The most effective behaviors for doing this include avoiding direct exposure to sunlight (glass does not block UVA rays from penetration), application of a broad spectrum, high SPF (30+) sunscreen, and wearing protective clothing including a wide-brimmed hat, pants, and long sleeves.

c. Antifungal

i.Griseofulvin (Griseovin)

Griseofulvin is an oral medication used to treat ringworm, jock itch, athlete's foot, nail disease and various fungal infections. It is sold under the brand names Fulvicin, Grifulvin, and Gris-PEG. This medicine is a derivative of the fungus Penicillium griseofulvum. By interfering during a process known as mitosis, this drug has the ability to impede fungal reproduction, ultimately causing the fungus to die without creating offspring that can continue to harm the patient.

Symptoms of these illnesses often begin to improve within a few days of starting the medication, although the duration of treatment can last much longer. Thus, those taking griseofulvin must often remain on the medication for a number of weeks or months with the duration of the treatment depending on the area affected. For example, the medication is required for 2 to 4 weeks for those with a skin infection, 4 to 6 weeks for hair or scalp infections, 8 weeks for foot infections, and 3 to 4 months for fingernail infections.

Side effects from this medication are rare, although nausea, headaches, fatigue and dizziness do occur in some patients. It is important to note that griseofulvin can also cause photosensitivity, meaning that the skin reacts abnormally to sunlight, often developing a rash. In order to prevent this from occurring it is crucial that patients apply a broad spectrum, high SPF (30+) sunscreen, wear protective clothing including sunglasses, a wide-brimmed hat, long sleeves and pants, and avoid direct sunlight when possible.

d. DMARD

i.Hydroxychloroquine

Hydroxychloroquine is a member of a group known as ‘antimalarial drugs', which are used to treat and/or prevent malaria. It also falls under the category of DMARDs, or Disease-Modifying Antirheumatic Drugs. This medication, sold under the brand name Plaquenil, does not, however effectively eliminate malaria strains that are chloroquine resistant. In addition, hydroxychloroquine is helpful in treating unresponsive cases of discoid or systemic lupus erythematosus and rheumatoid arthritis, especially when the drug is combined with other medications. When it is used to cure these diseases, the drug minimizes rashes and outbreaks in lupus and reduces swelling in those with arthritis.

In malaria-prevention treatments, hydroxychloroquine is most often taken one time per week and is started two weeks prior to arrival in the malaria-infected region, where the same dosage is required. After leaving the area the medication continues to be taken once per week for 4 to 8 weeks. It is crucial to continue the treatment even after leaving the infected region, as stopping the medicine early can result in development of the disease.

Hydroxychloroquine can sometimes cause headaches, stomach aches, dizziness or vomiting. To minimize nausea and other stomach related illnesses it can help to take the medicine with a glass of milk or food. In addition, this drug can cause a rash on skin that has become photosensitive, meaning that it reacts abnormally to ultraviolet light from the skin. Behaviors that decrease the likelihood of such an outbreak include avoiding exposure to sunlight when possible, wearing protective clothing such as long sleeves, pants and a wide-brimmed hat, and applying a broad spectrum, high SPF (30+) sunscreen.

e. Diuretic

i.Furosemide

Furosemide is used to lower blood pressure by acting as a diuretic, which in turn limits the likelihood of experiencing a stroke, heart attack or kidney failure. By increasing urine output and lowering the amount of water found in the body, a patient's blood pressure is also lowered. Edema is another serious medical condition in which a portion of the body becomes swollen, at which point furosemide can be prescribed so that the excess water in the body can be reduced. It is very important that the drug is used only as prescribed since an overdose of the medication can result in severe water and mineral loss, which can eventually cause dehydration. In addition, furosemide can cause calcium and phosphorous levels in the blood to decrease, in which case medical attention will be necessary. Furosemide is sold under the brand names Delone, Detue, and Lasix.

This drug has a few common side effects that one must be cautious of when taking the medicine that include dizziness, drowsiness and blurred vision. Because of these symptoms it is important to be very careful when treatment begins in order to avoid accidents. In addition, sensitivity to sunlight is heightened by this medication, making it very important for patients to apply a broad spectrum, high SPF (30+) sunscreen and wear protective clothing when they cannot avoid being exposed to sunlight.

ii.Hydroxychloroquine

Hydroxychloroquine is a member of a group known as ‘antimalarial drugs', which are used to treat and/or prevent malaria. It also falls under the category of DMARDs, or Disease-Modifying Antirheumatic Drugs. This medication, sold under the brand name Plaquenil, does not, however effectively eliminate malaria strains that are chloroquine resistant. In addition, hydroxychloroquine is helpful in treating unresponsive cases of discoid or systemic lupus erythematosus and rheumatoid arthritis, especially when the drug is combined with other medications. When it is used to cure these diseases, the drug minimizes rashes and outbreaks in lupus and reduces swelling in those with arthritis.

In malaria-prevention treatments, hydroxychloroquine is most often taken one time per week and is started two weeks prior to arrival in the malaria-infected region, where the same dosage is required. After leaving the area the medication continues to be taken once per week for 4 to 8 weeks. It is crucial to continue the treatment even after leaving the infected region, as stopping the medicine early can result in development of the disease.

Hydroxychloroquine can sometimes cause headaches, stomach aches, dizziness or vomiting. To minimize nausea and other stomach related illnesses it can help to take the medicine with a glass of milk or food. In addition, this drug can cause a rash on skin that has become photosensitive, meaning that it reacts abnormally to ultraviolet light from the skin. Behaviors that decrease the likelihood of such an outbreak include avoiding exposure to sunlight when possible, wearing protective clothing such as long sleeves, pants and a wide-brimmed hat, and applying a broad spectrum, high SPF (30+) sunscreen.

f. Herbal Antidepressant

i.St. John's Wor

St. John's Wort is an orally taken herbal medication that comes from a plant with yellow flowers. It is often used to alleviate mental illnesses, depression, anxiety and sleep disorders, and was at one time used as a treatment for wounds and malaria. While many people take St. John's Wort as a treatment for depression, certain studies have demonstrated that it is not effective in reducing depression any more than a placebo would be. As other studies have made the opposite conclusion, a definitive answer regarding the true impact of this herbal medicine has not yet been reached.

It is very important that anyone taking St. John's Wort inform their health care provider that they have begun using this medication. This is because the drug has not been approved by the FDA for use in treating depression or other disorders. Sometimes St. John's Wort will be ineffective in curing depression, causing the disorder to become much more severe the longer it remains untreated. In addition, the herb can react with other medications or substances in the body, in particular antidepressants, causing an undesirable response. Speaking with a doctor about such unintended interactions is also very important for patients receiving this medicine.

Those that are taking St. John's Wort often suffer from an increased sensitivity to the sun, also known as a photosensitivity response, which can cause the skin to develop abnormal rashes. In order to avoid this, it is important that patients avoid direct sun exposure when possible. Also, covering the skin with long sleeves, pants, and a wide-brimmed hat, as well as applying a broad spectrum, high SPF (30+) sunscreen can be helpful in minimizing outbreaks due to the sun's rays.

g. NSAID

i.Ibuprofen

This commonly used medication belongs to a group of drugs called nonsteroidal anti-inflammatory drugs, or NSAIDs, which reduce pain, aching, swelling and tenderness. It can be a prescribed to those with menstrual cramps or rheumatoid arthritis or osteoarthritis. In addition, it is also used as an over the counter, non-prescribed drug for treating an assortment of mild pains such as backaches, headaches, toothaches, muscle aches and the common cold. This medication is sold under the brand names Advil, Motrin, and Nuprin.

Ibuprofen functions by minimizing the production rate of the enzyme that produces prostaglandins, which are molecules that cause people to feel pain. By eliminating these enzymes a person in pain no longer feels uncomfortable. In order to maximize the effectiveness of the drug it is important to use the ibuprofen as soon as pain is experienced, as the potency of the medicine decreases as pain becomes increasingly intense.

Ibuprofen occasionally causes side effects involving the stomach including nausea or intestinal bleeding, although these are relatively rare occurrences. Over-the-counter ibuprofen should not be taken for a period greater than 10 consecutive days without seeing a doctor.

Another problem, although it is relatively uncommon for those taking ibuprofen, is developing a skin rash due to photosensitivity. To minimize the likelihood and the extent of an outbreak, it is important to avoid sunlight when possible. If exposure to UV radiation is not possible, application of a high SPF sunscreen and wearing protective clothing such as a wide-brimmed hat, pants and long sleeves can aid in defending the skin.

ii.Ketoprofen

Ketoprofen is a medication that is used to minimize pain and swelling caused by arthritis, tooth aches, backaches or menstrual cramps. This drug can also be helpful in reducing fever or other symptoms of the common cold or the flu. Ketoprofen is sold under the brand names Orudis, Actron, and Oruvail, and is a member of the medicine family known as NSAIDs or Nonsteroidal Anti-Inflammatory Drugs.

Those taking ketoprofen occasionally develop photosensitive skin, in which abnormal reactions to sunlight commonly occur. In order to avoid this it is important that patients avoid direct sunlight when possible. Additionally, applying a broad spectrum, high SPF (30+) sunscreen and wearing protective clothing such as pants, long sleeves and a wide-brimmed hat are all helpful behaviors in minimizing outbreaks.

iii.Naproxen

Naproxen is a medication sold under the brand names Anaprox, Naprelan, Naprosyn, and Aleve, and it can be found in both prescribed and non-prescribed forms. When it is prescribed, the drug relieves discomfort and pain caused by many forms of arthritis including rheumatoid, juvenile, ankylosing spondylitis and osteoarthritis, as well as tendonitis, gout, and other diseases that cause pain. When the non-prescription form of naproxen is used, it can treat fever, common mild pains and aches caused by arthritis and menstruation.

This medication falls under a category of drugs known as NSAIDs, or nonsteroidal anti-inflammatory drugs. The members of this group of substances minimize pain by reducing the amount of prostaglandins produced in the body, which are molecules that trigger a painful sensation in injured parts of the body. With lower levels of prostaglandins in the blood, the body is less likely to become inflamed, produce a fever, or experience pain.

Naproxen can cause a number of side effects when combined with other medications. It can result in an excess of lithium, a substance that is toxic in high amounts, to be excreted by the kidneys. The medication can also lower the blood pressure, an effect that might be contrary to desired conditions within the body.

Studies have not determined whether or not naproxen can damage a developing fetus, but until it has been proven safe it is not recommended that women become pregnant while taking the medication. In particular, NSAIDs are often transmitted through breast milk and can be harmful to a newborn that is breast feeding on this milk. Therefore it is important that women taking this drug inform their doctors of this decision.

Those taking naproxen sometimes experience photosensitivity, in which the skin develops abnormal rashes upon being exposed to sunlight. In order to defend oneself against this, it is important that those taking the medication minimize direct exposure to sunlight, apply a broad spectrum, high SPF (30+) sunscreen, and cover as much skin as possible with protective clothing.

h. Phenothiazine

i.Chlorpromazine

This oral medication has been used most often over past decades for treating mental disorders and is sold under the brand names Chlorpromazine Hydrochloride Intensol and Thorazine. This drug falls under a category of medications known as phenothiazines that all function by stabilizing the chemical components of the brain, often allowing a person's previous mental illnesses to fade. Such disorders include hallucinations, delusions, and hostility. Chlorpromazine is also used to treat children with severe behavior problems or chronic nausea.

While phototoxicity reactions are rather common in patients that are taking the medicine, the chemicals causing this response can be so potent that even pharmacists who handle the drug occasionally experience photosensitivity. This reaction can cause areas of the skin that have been exposed to sunlight to become slate-gray in coloring as a result of the chlorpromazine mixing with melanin. Because of this it is recommended that anyone taking the medication avoids sunlight whenever possible. If exposure to the sun does occur, application of a broad spectrum, high SPF (30+) sunscreen and wearing protective clothing that covers as much skin as possible can be helpful.

The medication often takes 2-3 weeks for improvements to be observed, a characteristic of chlorpromazine that can frustrate patients. If the condition becomes worse or does not improve following this period of time, it is important that patients contact their doctor. In addition, stopping the medication should be done slowly as the body can have uncomfortable reactions (although the medication is not addictive) if it is stopped suddenly.

i.Retinoid

i.Acitretin

Acitretin is most often prescribed as a treatment for psoriasis, a skin disorder characterized by erythema, (red and swollen skin) and plaques (whitish-gray scales). This medication does not permanently stop psoriasis outbreaks from occurring, but can minimize outbreaks while the drug is being taken. Often, however, it takes 2-3 months before this occurs is many patients. Acitretin is also used to treat other diseases including Darier's Disease and other disorders related to the skin. It is classified as a retinoid and is sold under the brand name Soriatane.

Acitretin can cause birth defects and therefore pregnancy is prohibited in women that are taking the medication or those that have not been off of the medication for longer than two months. In addition, fertile women that are taking the medicine are required to also be on a minimum of two contraceptives and must undergo a pregnancy test once a month in order to refill their prescription. It is crucial that women do not drink alcohol while taking this medicine as the two substances can combine to form a chemical that remains in the body for a long time and can harm a developing fetus. A small amount of acitretin is found in semen, but it is unknown if this amount can actually cause harm to a fetus, and therefore it is recommended that men discuss their situation with a doctor prior to conceiving a child.

A number of precautions must be followed while taking this medication. Acitretin can cause blood sugar levels to become abnormal, so it is important that anyone taking the medication discusses this with their doctor. Sunlight can also irritate the skin, making it crucial to protect oneself by wearing protective clothing such as a wide-brimmed hat, long sleeves and pants. Another important defensive step to take is to apply a high SPF sunscreen to any exposed areas.

ii.Isotretinoin

Isotretinoin is an oral retinoid most often used to cure severe cystic or nodular acne that has been unresponsive to other treatments. This medication is sold under the brand names Accutane, Amnesteem, Claravis, and Sotret. Isotretinoin causes the amount of oil produced by the face to dramatically decrease, in turn reducing facial acne. The drug has been identified as causing severe birth defects for the babies of those women taking it, and therefore pregnant women cannot be prescribed the medication. In addition, those women that are taking isotretinoin are required to take monthly pregnancy tests, known as the iPLEDGE program. It is recommended that women do not become pregnant less than a year following the end of their treatment with this medication.

Those on isotretinoin often have acne and therefore have sensitive skin prior to starting the medication. Once a patient is taking this drug, however, the skin can become even more photosensitive, meaning that many forms of natural or artificial ultraviolet radiation can irritate the skin. Therefore it is important that those taking isotretinoin avoid exposure to sunlight whenever possible, apply a broad spectrum, high SPF (30+) sunscreen to any exposed skin, and wear protective clothing such as long sleeves, pants and a wide-brimmed hat when they are outdoors.

2. Topical

a. Antineoplastics

i.5-Fluorouracil

Fluorouracil (5-FU) is a form of chemotherapy that falls within the group of drugs known as antineoplastics. The treatment is delivered in the form of an injection, topical cream, or an oral medication (sold by the brand names Adrucil, Carac, Efudex and Fluoroplex). Most commonly this drug is used as a treatment for colon, rectal, stomach, pancreatic and breast cancers, although it has also been proven effective in a large number of cases involving ovarian, cervical and bladder cancer. The medication acts as an antimetabolite, meaning that it disturbs the growth cycle of cells. The molecule appears to be a vital nutrient to the cancerous cells that engulf the drug. Once inside the cell, however, the molecule interferes with the production of RNA. This in turn stops new copies of DNA from being made in the cell, which causes the cell to stop reproducing and to eventually die.

Fluorouracil causes the skin to become red or blister and treated skin will often become very dry and peel away. In addition, the skin can become irritated, sting, or a sunburn can develop quickly. Because of this new photosensitivity, it is very important that those receiving doses of fluorouracil defend their skin from damage due to the sun's rays by avoiding exposure when possible, applying a broad spectrum, high SPF (30+) sunscreen to exposed areas, and wearing protective clothing.

When taken orally or intravenously, fluorouracil has the potential to cause a number of other side effects including hair loss, nausea and vomiting. The medication can also interfere with the menstrual cycle in women or sperm production in men, although this does not occur in everyone. It is important to use birth control while undergoing chemotherapy, as pregnancy is not advisable for women receiving treatments of fluorouracil.

b. Furocoumarins

i.Psoralen

The term ‘psoralen' describes a group of medications that darken the skin upon reacting with UVR. A procedure known as PUVA combines psoralen and UVA light in an attempt to treat certain diseases of the skin such as psoriasis. UVA does not normally improve the psoriasis without the help of an additional drug. Psoriasis causes cells to reproduce at a very rapid rate, which is slowed by the usage of PUVA therapy.

Psoralen is administered orally approximately 75 to 120 minutes prior to the skin is to be exposed to UVA. The medication can also be topically applied by a ‘soak,' in which individual body parts are submerged in psoralen dissolved in water, or in a ‘bath,' in which the entire body is submerged. Those that are taking the medicine topically risk higher chances of having a photosensitive response in which the skin breaks out into a rash or is easily burned. Other side effects of the medication include nausea, itching, redness, and the development of cataracts.

Psoralen occasionally causes photosensitivity of the skin, which, in combination with the UVA light used to treat psoriasis, can cause an undesirable reaction of the skin. Most importantly, the psoralen can cause skin cancer to develop, which requires immediate attention and removal by a dermatologist. In order to prevent further irritation by the sun, it is important to reduce the amount of time spent in direct sunlight and to eliminate it if possible. Additionally, the application of a broad spectrum, high SPF (30+) sunscreen and wearing protective clothing can be useful behaviors in defending oneself from the harms of the sun.

c. Keratoplastics

i.Coal Tar

Coal tar is the liquid form of coal that has been distilled at extremely high temperatures. The crude tar tends to be black and very thick, although it comes in solutions of varying concentration, from 0.1 % to 20%. It is often combined with other substances and used in the form of shampoo, creams or ointments, and is then applied to treat eczema or psoriasis, especially on the scalp. This medication is useful because it is less toxic than other drugs used to treat the same diseases, and also because it is less expensive to produce.

A number of recommendations have been made for those using coal tar, including applying the medicine at night due to its unpleasant scent and tendency to stain both skin and clothing. It is also advised that those using coal tar leave the solution on for at least two hours and that they avoid application of the tar on blistered or infected areas of skin.

Coal tar also acts as a photosensitizing agent, meaning that it may cause the skin to become sensitive to UV light. In order to minimize irritation of the skin, it is important to avoid the sun when the tar has been applied. In addition, wearing protective clothing and applying a broad spectrum, high SPF (30+) sunscreen can reduce the chances of developing a rash.

d. PDT Pro-photosensitiser

i.5 - Aminolevulinic Acid

Aminolevulinic acid, sold under the brand name Levulan, is a topical medication (meaning that it is directly applied to the skin) that is utilized during a process called photodynamic therapy, or PDT. This procedure is used to eliminate abnormal skin cells that may form actinic keratoses (AK), acne vulgaris or squamous cell carcinomas. Following application of this medication, a lamp that emits a controlled amount of blue light is shined onto the skin that has been treated with the aminolevulinic acid. The energy from the light causes the molecules of the drug to change shape, destroying abnormal cells in the process.

After a PDT session has been completed, the skin will often become sensitive to bright lights, especially halogen and ultraviolet rays. Exposure to this light can very quickly result in irritated skin. Redness and swelling are the most common reactions to sunlight upon undergoing this treatment. In addition, burning, stinging or tingling sensations occasionally occur in those using PDT.

In order to avoid the above-mentioned side effects, it is crucial that patients notify their doctor of any other medications that they might be taking. This is necessary because certain drugs cause the skin to become photosensitive, meaning that these substances will cause skin to form rashes or outbreaks, which can become much more severe upon exposure to sun following a PDT session. In addition, it is important that that those undergoing this treatment also protect their skin by covering as much as possible from exposure to light by wearing pants, long sleeves, a wide-brimmed hat and sun glasses. Diligent use of a broad spectrum sunscreen is required for 48 hours following PDT.

e. Retinoid

i.Tazarotene

Tazarotene is a medication that is used to treat psoriasis or acne and is sold under the brand names Tazorac, Avage, and Zorac. This drug is a retinoid that is found in the form of a topical cream that can be applied to the face or other affected areas, but only a small amount should be placed on these regions.

Occasionally tazarotene will cause the skin to itch, burn, become red, sting or develop scales on the region where the cream has been applied. These areas can be further irritated by electrolysis, waxing or other hair removal products, which should all be avoided when tazarotene is being used.

Fetuses can be harmed by tazarotene and therefore women using the cream should not become pregnant while they are using the medication. In addition, those that are using this drug and are fertile must have a pregnancy test within two weeks of beginning the medicine to prove that they are not endangering a fetus by taking the drug. The impact that tazarotene has on breast milk is not yet known, making it highly advisable for women to speak to their doctor prior to beginning breastfeeding.

Tazarotene may also cause the skin to become photosensitive, meaning that any exposure of the skin to light can result in an abnormal outbreak or rash. To defend against this, those taking this medication should minimize the amount of time spent exposed to direct sunlight. Moreover, a broad spectrum, high SPF (30+) should be applied to any exposed skin and protective clothing should be worn whenever possible.

i.Tretinoin

Tretinoin is a medication that is most commonly used to manage acne. It causes the skin in affected areas to peel off and can also minimize the number of new pimples that form. This medication has been observed to quickly heal areas of acne and to unclog pores. Tretinoin is also used to improve overall skin quality by eliminating lines and wrinkles on the face and reducing roughness. This medication is a member of the retinoid family and is sold under the brand name Retin-A for acne treatment and Renova for treatment of photoaged skin. It is applied as a topical liquid, cream or gel.

Those using tretinoin sometimes experience irritated and reddened skin within the first week of starting the medication, but this is not abnormal. Effects of using this medication are usually not observed for 2-3 weeks following the first application. Tretinoin should be applied on a daily basis unless notified otherwise, and should be continued even if slight aggravation of the skin does occur. If this irritation worsens or does not appear to subside, a doctor should be informed before discontinuing the medicine.

Irritated skin can often become more intensely exacerbated if it is exposed to the ultraviolet rays of the sun. Such a photosensitivity response can be minimized by avoiding sunlight when possible. In addition, application of a broad spectrum, high SPF (30+) sunscreen and wearing protective clothing can reduce the effects of UV light.

f. Other Photosensitizing Agents

i.Sunscreens

Sunscreens are topical creams that are applied in order to minimize the damaging effects of the sun on exposed skin. While it is best to avoid tanning and direct exposure to sunlight, sunscreen can act as a protective agent against damage by UV radiation. Sunscreen can be purchased in various forms, with a large range in the strengths and ingredients available to consumers.

One of the most important things to note about a sunscreen when purchasing it is its SPF, or Sun Protection Factor. A higher SPF indicates more protection against UVB rays. The SPF value indicates the ratio of time that a person can stay in the sun before being sunburned with and without wearing sunscreen. For example, a person wearing an SPF 15 sunscreen can remain in the sun 15 times longer than they normally could before they are burned. Those with sensitive skin are advised to wear SPF 30+ sunscreen. For people with darker or less sensitive skin a weaker sunscreen may be sufficient.

Another important quality to note when finding a suitable sunscreen is whether or not it is a broad-spectrum sunscreen. The skin can be damaged by both UVA and UVB rays from the sun. As mentioned, the SPF of a sunscreen indicates its ability to block UVB rays, which cause sunburn. UVA rays, however, are also responsible for damaging the skin, but will cause wrinkles, skin aging, and other long-term effects. In order to minimize the chance of such damage, it is important to purchase a broad-spectrum sunscreen that also blocks UVA.

Although the purpose of sunscreen is to reduce the damaging effects of sunlight on the skin, it can actually cause an increased sensitivity of the skin in a minority of the people that use it. The following details those ingredients that have been found to increase sensitivity of the skin to UV rays.

PABA, or para-aminobenzoic acid, and its derivatives have been linked to increasing the sensitivity of the skin and to causing a particular DNA defect in some of those that are exposed to it. Users that experience this response will observe their skin to become red and irritated. It is important to wash away the sunscreen in this situation and to switch to another type that does not contain PABA. This compound is rarely found in sunscreens anymore do to its photosensitizing qualities.

Cinnamates are substances used in sunscreens to protect the skin from the UVB rays of the sun. One cinnamate in particular, commonly known as Parsol MCX, tends to be insoluble in water, causing the products that contain the compound to be labeled as ‘waterproof.' Cinnamates occasionally result in allergic reactions, although this response is much less common than the reaction caused by PABA.

Benzophenones are commonly used UVB absorbers. Benzophenone-3 is the most prominent member of the group to be found in sunscreens due to the fact that it also absorbs UVA II, classifying it as a broad-spectrum absorber. This group has been found to be one of the most common sources of photosensitive reactions in the United States.

Salicylates were the first group to be used in the US as sunscreen. Today sunscreens are largely composed of octyl salicylate, which is a weak UVB absorber. Because it is not very powerful, sunscreens can use large amounts of it without causing damage to the skin. In addition, salicylates have the ability to dissolve other sunscreen components that are not readily soluble (such as benzophenones), but the salicylate itself remains insoluble in water. Salicylates can cause an allergic reaction, but this is rather uncommon.

ii. Fragrances

Certain fragrances have been characterized as inducing photoallergic reactions. These substances cause contact dermatitis, in which the skin most often develops a rash of small red bumps and inflamed skin. This outbreak most commonly develops on the face, arms and hands and can appear between a few minutes or up to two days following exposure to the irritant. An allergy to certain fragrances can be tested by a using an allergy mix test that detects about 75% of fragrance-related allergies.

A common fragrance irritant is musk ambrette, which is a synthetic substance that causes a contact dermatitis that is usually found on the face. It has been used for more than 60 years and is found in soaps, detergents, creams, and lotions.

Another common irritant is coumarin, which is the common name for the molecule 6-methylcoumarin. This fragrance has a sweet vanilla-like smell and has been observed to be an anti-fungal and blood thinning agent. This substance has also been observed to cause contact dermatitis.